Percutaneous tenontotomy of the Achilles tendon

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Percutaneous tenontotomy of the Achilles tendon

• Often plastering correction is not sufficient to
  overcome the deformity hence the necessity to
  make a percutaneous tenontotomy . This is work
  for doctors to perform.

Preparing for tenontotomy
Percutaneous tenontotmy of the Achilles tendon
Maximum abduction
maximum dorsiflexion
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Post plastering correction follow up

• Night splint wearing (Steenbeek) for the
  maintenance of the correction
• Daylight splint wearing (levator) for the
  maintenance of the correction
• Re-education (softening of the muscles if
  necessary)

Attelle de nuit
Attelle de jour
Attelle de nuit
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Results1 Health agents training
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Results 2 Nomber of treated patients from
Octobre 2006 to February 2009 per centre

• Conclusion this chart shows that the male sex
  is more often victim of the congenital deformity
  than the female sex (PBVE).

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Results 3 situation of the patients treated from
Octobre 2006 to February 2009
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Results 4 Evaluation of performances Cases of
203 patients treated consisting of 80 bilateral
and 123 unilateral (68 right legs and 55 left
legs)
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Results 4 Evaluation of performances
(continued)

• An analysis of these results shows that out of
  1255 responses, we have
• 1174 times where satisfaction has been reached at
  least with the average of 3/5 that is 93,5
  versus
• 81 times with non satisfaction, that is 6,5
• As a conclusion, we can say that the Malian
  experience as regards club foot with the Ponséti
  method has been a 93,5 of C success

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Obstacles met

• Despite these results we often meet with
  difficulties that are generally related to  
• Accessibility of the treatment centres due to
  distance
• Treatement of equin varus club foot in the
  centres where services are paid
• Lack of parental home monitoring for plastered
  children who often come back to us with defective
  plasterings during the first phase of treatment
• Regular wearing of night splints after the first
  phase of treatment (plastering)
• Lack of mastery in the making of night splints by
  cobblers

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Obstacles met (continued)

• Non respect of appointments for children follow
  up after the first phase of treatment.
• Availability of regular raw materials stocks
• Lack of mastery over the Ponséti method by
  certain therapists .
• Failur in some tenontotomy or operated cases
• Different methods of trainers in relation to day
  light splint wearing
• Frequency of recurrence

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